Üreter Taşlarının Taş Dansitesi, Cilt-Taş Mesafesi ve Taş Boyutunun Ekstrakorporeal Şok Dalgası Litotripsi Başarısına Etkisi: Bir Klinik Araştırma

Year 2025, Volume: 20 Issue: 1, 1 - 12, 27.02.2025

Erhan Erdoğan , Fatih Özçelik , Gül Kahraman , Mihriban Şimşek , Kemal Sarıca

https://doi.org/10.33719/nju1560480

Abstract

Amaç: Bu çalışmada, üreter taşları için ekstrakorporeal şok dalgası litotripsi (ESWL) uygulanan hastalarda demografik özellikler, taşın boyutu, dansitesi ve lokalizasyonu, cilt-taş mesafesi (SSD) ve idrar parametreleri ile ESWL tedavi başarısı arasındaki ilişki araştırılmaktadır.
Yöntemler: Bu çalışmaya üreter taşı nedeniyle ESWL tedavisi alan toplam 151 hasta dahil edildi, 116’sında ESWL tedavisi başarılıydı. Taş boyutu, dansitesi ve üreter lokalizasyonu (üst/alt ve sağ/sol) non-kontrast bilgisayarlı tomografi kullanılarak değerlendirildi ve SSD ölçüldü. Demografik özellikler (yaş, cinsiyet ve BMI) ve tam idrar testi parametreleri (pH, yoğunluk, protein, lökosit, eritrosit, silendir ve çeşitli kristal tipleri v.b.) kaydedildi. Bu faktörlerin ESWL başarısına etkisi istatistiksel olarak incelendi.
Bulgular: ESWL başarısı ile taş dansitesi (HU cinsinden), SSD ve hasta yaşı arasında önemli bir negatif ilişki olduğu gösterildi. Yumuşak taşlara (HU<1000) kıyasla sert taşların (HU≥1000) tedavi başarısının azalmış olduğu tespit edildi (sırasıyla ESWL başarısı: 88/106 (83%)’e karşı 28/45 (62%), p= 0.006). Benzer şekilde, ESWL başarılı olanların başarısız olanlara kıyasla hasta yaşı ve SSD daha düşük bulundu (sırasıyla 41±13’e karşı 45±9 yaş ve 117±18’e karşı 125±17 mm). Ayrıca yoğunluğu yüksek olan taşların yoğunluğu düşük olanlara göre daha büyük olduğu ve aralarında düşük düzeyde de olsa pozitif bir korelasyon olduğu tespit edildi. (9.0(4.8-15.0)’e karşı 7.8(4.2-15.0) mm, p=0.0458; r=0.240, p=0.0029). Binary regresyon analizinde SSD, taş dansitesi (HU) ve taş lokalizasyonu bağımsız değişkenlerinin ESWL başarısını anlamlı derecede etkilediği ve %78.8 doğrulukla tahmin edebildiği saptandı (sırasıyla, 0.005, 0.002 ve 0.014).
Sonuç: Taş dansitesinin yüksekliği, uzun SSD değeri ve ileri yaş; ESWL tedavisinin başarısını düşürebilmektedir. Bu çalışma, ESWL tedavisinin planlanması sırasında bu değişkenlerin değerlendirilmesinin önemini vurgulamaktadır.

Keywords

Yaş, ESWL başarısı, Cilt-taş mesafesi, Taş dansitesi (HU)

Effect of Stone Density, Skin-Stone Distance and Stone Size on Extracorporeal Shock Wave Lithotripsy Success of Ureter Stones: A Clinical Investigation

Abstract

Objective: This study aimed to investigate the correlation between demographic characteristics, stone size, density, and location, skin-to-stone distance (SSD), urinary parameters, and the success rate of extracorporeal shock wave lithotripsy (ESWL) in patients with ureteral stones.
Material and Methods: A total of 151 patients with ureteral stones were included in this retrospective study, and ESWL treatment was successful in 116 of them. Stone size, density, and ureteral location (upper/lower and right/left) were evaluated using non-contrast computed tomography, and SSD was measured. Demographic characteristics [age, gender, and BMI (Body Mass Index)] and complete urinalysis parameters (pH, specific gravity, protein, leukocytes, erythrocytes, casts, and various crystal types) were recorded. The impact of these factors on ESWL success was statistically analyzed.
Results: A significant negative correlation was found between ESWL success and stone density [in Hounsfield units (HU)], SSD, and patient age. Treatment success was lower for hard stones (HU ≥ 1000) compared to soft stones (HU < 1000) (ESWL successful: 28/45 (62%) vs 88/106 (83%), p = 0.006). Similarly, patients with successful ESWL had lower ages and SSD compared to those with unsuccessful outcomes (41±13 vs 45±9 years and 117±18 vs 125±17 mm, respectively). Additionally, stones with higher density were found to be larger compared to those with lower density, with a low-level positive correlation (9.0(4.8-15.0) vs 7.8(4.2-15.0) mm, p=0.0458; r=0.240, p=0.0029). Binary regression analysis revealed that SSD, stone density (HU), and stone location significantly influenced ESWL success and could predict outcomes with 78.8% accuracy (p=0.005, 0.002, and 0.014, respectively).
Conclusion: Increased stone density, longer SSD, and advanced age can decrease the success of ESWL treatment. This study highlights the importance of considering these variables when planning ESWL treatment.

Keywords

age, ESWL successful, skin-stone distance, stone density (HU)

Ethical Statement

Ethical Approval for this study was obtained from the Sancaktepe Training and Research Hospital Clinical Research Ethics Committee (Decision No: 2024/298, dated 24.09.2024, numbered E-46059653-050.99-254458275). All patients participating in the study were informed about the study and their informed consent was obtained.

Supporting Institution

The authors declared that this study received no financial support.

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